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OBJECTIVE@#To compare the effectiveness of abdominal placement of indwelling Foley catheter (IFC)versus thigh traction in the prevention of bleeding and pain after transurethral resection of the prostate(TURP).@*PATIENTS AND METHODS@#This randomized, controlled trial involves 91 patients who underwent TURP atJRRMMC. After TURP, 46 patients were inserted with a urethral catheter which was then anchoredto the thigh and placed on traction, while the catheter was anchored to the abdomen without applicationof any traction in the remaining 45. A simple dipstick test was used to check for the presence of bloodin urine on the 12th and 24th hour after the surgery. Intensity of pain from the catheter was assessedprior to discharge using a visual analogue score (VAS).@*RESULTS@#There were no significant differences between the two groups in terms of the amount of bloodin the urine at the 12th hour (p=1.00) and 24th hour (p=0.427) after TURP. The mean VAS score wassignificantly higher for the thigh traction group (5.17 vs 1.51, p=0.0001). Additionally, there weremore patients in the IFC thigh traction group who complained of moderate (65% vs 4.4%, p= 0.0001)and severe (20% vs 4.4%, p= 0.0001) pain.@*CONCLUSION@#Abdominal placement of IFC post TURP is an effective, safe and comfortable way incontrolling post-operative bleeding post-TURP. This method can provide better pain control.
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Objective To evaluate the efficacy and safety of transurethral laser shovel type vaporresection-enucleation of the prostate (LS-VREP) based on the inter-layer of surgical capsule for the treatment of benign prostatic hyperplasia (BPH),which was less 80 g weight.Methods From September 2013 to August 2016,a retrospective study was performed including 1 369 cases of BPH patients,who were treated by 120-160 W transurethral laser (straight green-light) shovel type vapor-resection-enucleation of the prostate (LS-VREP group,n =1 008) and transurethral resection of the prostate (TURP group,n =361).The preoperative data,including average age,prostate weight,IPSS,QOL,Qmax and PVR was reviewed.There was no significant difference of the above data between the two groups (P ＞ 0.05).Operative time,changes of hemoglobin and serum sodium concentration,postoperative bladder irrigation time,catheter indwelling duration,hospital stay,pre-and 3 months post-operative IPSS,QOL,Q PVR were recorded.In addition,complications were monitored.Results Mean operation time of LS-VREP group was (46.1 ± 18.6) min,while TURP group was (48.2 ± 15.2) min,and there was no difference between the two groups (P ＞ 0.05).Post-operative mean hemoglobin concentration and serum sodium concentration of LS-VREP group decreased (1.6 ± 1.2) g/L and (1.2 ± 0.6) mmol/L respectively,while those of TURP group decreased (5.7 ± 3.6) g/L and (3.2 ± 1.2) mmol/L,and the differences were statistically significant (P ＜ 0.05).Mean post-operative catheter indwelling time,and post-operative hospital stay of LS-VREP group was (42.9 ± 12.7) h and (3.2 ± 0.6) d,while TURP group was (65.7 ± 15.4) h and (5.4 ± 1.2) d,and the differences were statistically significant (P ＜ 0.05).Comparatively IPSS,QOL,Qmax and PVR were all improved significantly in both groups at 3 months after operation (P ＜ 0.05),but no significant difference was found between the two groups (P ＞ 0.05).After three months' follow-up of post-operation,as for the complication rate,including TURS,bleeding requiring reoperation,incontinence,dysuria and erectile dysfunction,LS-VREP group (15/1 008) was less than that of TURP group (30/361,P ＜ 0.05).Conclusions The LS-VREP based on the inter-layer of surgical capsule is safe and effective for the treatment of BPH patients whose prostate weight was less than 80 g.LS-VREP showed less intraoperative bleeding,faster postoperative recovery,and high safety,which is considered a safe,effective and optimized minimally invasive surgery.
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INTRODUCTION: Hematuria is a common complication of transurethral electrosurgical procedures in the postoperative period. Presently, there is no standard diagnostic tool that will determine the degree of hematuria among postoperative catheterized patients. An innovative way of assessing the degree of hematuria is through the use of Hematuria Meter Application, a mobile device software program.OBJECTIVE: The objective of this study was to determine the reliability of the Hematuria Meter Application as a diagnostic tool to assess the degree of hematuria in post-TURP and post-TURBT patients. This study aimed to determine if there is agreement between the Hematuria Meter Application readings and the RBCs counter per high power field by Direct Manual Quantitative Microscopy method and to determine if there is inter-observer agreement in using the Hematuria Meter Application between the patient or relative, nurse, intern and resident urologist.METHODS: Using the Hematuria Meter Application, the color of the urine was graded by the patient or relative, resident, intern and nurse. Urine was then collected and sent to the laboratory for quantitative manual RBC counting under the microscope. Intraclass correlation coefficient (ICC) was used to determine teh agreement of the applicatin readings with RBC/hpf and inter-observer agreement among the observers.RESULTS: From July 2014 to December 2015, a total of 159 eligible patients were included in this study. The average age was 69. Majority were males (91%). 118 patients out of 159 (74%) underwent TURP, while 41 patients (26%) underwent TURBT. The median age of patients who underwent TURP was 68 while the median age was 66 for patients who underwent TURBT.The agreements of the Hematuria Meter Application readings with RBCs/hpf counted with Direct Manual Quantitative Microscopy method were almost perfect. ICC was 0.743 (p-value 0.000) in day 0 post-operative and 0.985 (p-value 0.000) in day 2 post-operative. Similarly, inter observer agreement was almost perfect and increasing at each period of assessment. In the immediate post-operative period, ICC was 0.832 (p-value 0.000). On second post operative day, ICC was 0.999 (p-value 0.000).CONCLUSION: The Hematuria Meter Application is a reliable diagnostic tool in assessing the degree of hematuria in post-TURP and post-TURBT patients. There is inter-observer agreement in using this application.
Subject(s)
Humans , Male , Microscopy , Hematuria , Reproducibility of Results , Electrosurgery , Transurethral Resection of Prostate , Urologists , Erythrocyte Count , PhysiciansABSTRACT
INTRODUCTION: Erythrocyte Sedimentation Rate (ESR) is an acute phase reactant and an indirect measure of inflammation inside the body. Transurethral electrosurgical Resection of the Prostate (TURP) is the current gold standard for management of patients with Benign Prostatic Hyperplasia (BPH) with moderate to severe lower urinary tract symptoms. The success of operation is determined when after resection of the prostate following removal of indwelling Foley catheter several days postoperative, the patient is able to avoid freely without catheter. It is not mentioned whether the edema of the postoperative site or the persistent inflammation of the prostate after resection may cause the failureof trial of voiding without catheter (TWOC).OBJECTIVE: The primary objective of this study was to determine if ESR can be a reliable predictor of success of in patients who underwent TURP for BPH.METHODS: On the day of planned catheter removal , 4 milliliters of blood was extracted from the patient, placed in an Ethylenediaminetetraacetic acid (EDTA) tube and sent to laboratory for ESR determination. One milliliterof EDTA-anticoagulated blood was placed in the Westergren tube. After 60 minutes, measurements were taken of the distance the red cells traveled to settle at the bottom of the tube. After catheter removal, patients were observed whether they can avoid freely without catheter or not. Patients who were not able to void within 4 to 6 hours were re-catheterized.RESULTS: From January 2015 to April 2016, 135 patients with BPH who underwent TURP in East Avenue Medical Center were included in the analysis. Success of trial voiding without catheter was observed in 117 of 135 patients (87%; p=0.000). Patients ages varied varied from 49 to 80 years, overall. Among these patients, the average ESR was significantly lower (48 mm versus 56 mm, range = 17-109 mm; p=0.012). Presence of urinary retention (61%), history of cigarette smoking (56%), hypertension (61%), diabetes mellitus (50%), trabeculations in cystoscopy and prostate size less than 20 grams (17%) were more common among patients with unsuccessful TWOC. ESR (p=0.012) was an independent significant predictor of TWOC. Based on univariate analysis, Diabetes Mellitus (DM) (p=0.003), trabeculations in cystoscopy (p=0.000) and UTI (p=0.000) were also significantlyassociated with TWOC. Among the significant independent covariates, DM was a significant factor affecting the success rate of TWOC (p=0.005) based on multivariate analysis. Patients without DM were about 16 times more likely to have a successful TWOC (OR=15.750, 95% CI=2.335, 106.227).CONCLUSION: Erythrocyte Sedimentation Rate was significantly lower in patients with success of trial voiding without catheter. ESR is a reliable predictor of success of TWOC in patients who underwent TURP for BPH.
Subject(s)
Humans , Male , Aged , Middle Aged , Adult , Urinary Retention , Prostatic Hyperplasia , Edetic Acid , Transurethral Resection of Prostate , Urinary Catheterization , Lower Urinary Tract Symptoms , UrinationABSTRACT
@#<p style="text-align: justify;"><strong>INTRODUCTION:</strong> Hematuria is a common complication of transurethral electrosurgical procedures in the postoperative period. Presently, there is no standard diagnostic tool that will determine the degree of hematuria among postoperative catheterized patients. An innovative way of assessing the degree of hematuria is through the use of Hematuria Meter Application, a mobile device software program.<br /><strong>OBJECTIVE:</strong> The objective of this study was to determine the reliability of the Hematuria Meter Application as a diagnostic tool to assess the degree of hematuria in post-TURP and post-TURBT patients. This study aimed to determine if there is agreement between the Hematuria Meter Application readings and the RBCs counter per high power field by Direct Manual Quantitative Microscopy method and to determine if there is inter-observer agreement in using the Hematuria Meter Application between the patient or relative, nurse, intern and resident urologist.<br /><strong>METHODS:</strong> Using the Hematuria Meter Application, the color of the urine was graded by the patient or relative, resident, intern and nurse. Urine was then collected and sent to the laboratory for quantitative manual RBC counting under the microscope. Intraclass correlation coefficient (ICC) was used to determine teh agreement of the applicatin readings with RBC/hpf and inter-observer agreement among the observers.<br /><strong>RESULTS:</strong> From July 2014 to December 2015, a total of 159 eligible patients were included in this study. The average age was 69. Majority were males (91%). 118 patients out of 159 (74%) underwent TURP, while 41 patients (26%) underwent TURBT. The median age of patients who underwent TURP was 68 while the median age was 66 for patients who underwent TURBT.<br />The agreements of the Hematuria Meter Application readings with RBCs/hpf counted with Direct Manual Quantitative Microscopy method were almost perfect. ICC was 0.743 (p-value 0.000) in day 0 post-operative and 0.985 (p-value 0.000) in day 2 post-operative. Similarly, inter observer agreement was almost perfect and increasing at each period of assessment. In the immediate post-operative period, ICC was 0.832 (p-value 0.000). On second post operative day, ICC was 0.999 (p-value 0.000).<br /><strong>CONCLUSION:</strong> The Hematuria Meter Application is a reliable diagnostic tool in assessing the degree of hematuria in post-TURP and post-TURBT patients. There is inter-observer agreement in using this application.</p>
Subject(s)
Humans , Male , Microscopy , Hematuria , Reproducibility of Results , Electrosurgery , Transurethral Resection of Prostate , Urologists , Erythrocyte Count , PhysiciansABSTRACT
@#<p style="text-align: justify;"><strong>INTRODUCTION:</strong> Erythrocyte Sedimentation Rate (ESR) is an acute phase reactant and an indirect measure of inflammation inside the body. Transurethral electrosurgical Resection of the Prostate (TURP) is the current gold standard for management of patients with Benign Prostatic Hyperplasia (BPH) with moderate to severe lower urinary tract symptoms. The success of operation is determined when after resection of the prostate following removal of indwelling Foley catheter several days postoperative, the patient is able to avoid freely without catheter. It is not mentioned whether the edema of the postoperative site or the persistent inflammation of the prostate after resection may cause the failureof trial of voiding without catheter (TWOC).<br /><strong>OBJECTIVE:</strong> The primary objective of this study was to determine if ESR can be a reliable predictor of success of in patients who underwent TURP for BPH.<br /><strong>METHODS:</strong> On the day of planned catheter removal , 4 milliliters of blood was extracted from the patient, placed in an Ethylenediaminetetraacetic acid (EDTA) tube and sent to laboratory for ESR determination. One milliliterof EDTA-anticoagulated blood was placed in the Westergren tube. After 60 minutes, measurements were taken of the distance the red cells traveled to settle at the bottom of the tube. After catheter removal, patients were observed whether they can avoid freely without catheter or not. Patients who were not able to void within 4 to 6 hours were re-catheterized.<br /><strong>RESULTS:</strong> From January 2015 to April 2016, 135 patients with BPH who underwent TURP in East Avenue Medical Center were included in the analysis. Success of trial voiding without catheter was observed in 117 of 135 patients (87%; p=0.000). Patients ages varied varied from 49 to 80 years, overall. Among these patients, the average ESR was significantly lower (48 mm versus 56 mm, range = 17-109 mm; p=0.012). Presence of urinary retention (61%), history of cigarette smoking (56%), hypertension (61%), diabetes mellitus (50%), trabeculations in cystoscopy and prostate size less than 20 grams (17%) were more common among patients with unsuccessful TWOC. ESR (p=0.012) was an independent significant predictor of TWOC. Based on univariate analysis, Diabetes Mellitus (DM) (p=0.003), trabeculations in cystoscopy (p=0.000) and UTI (p=0.000) were also significantlyassociated with TWOC. Among the significant independent covariates, DM was a significant factor affecting the success rate of TWOC (p=0.005) based on multivariate analysis. Patients without DM were about 16 times more likely to have a successful TWOC (OR=15.750, 95% CI=2.335, 106.227).<br /><strong>CONCLUSION:</strong> Erythrocyte Sedimentation Rate was significantly lower in patients with success of trial voiding without catheter. ESR is a reliable predictor of success of TWOC in patients who underwent TURP for BPH.</p>
Subject(s)
Humans , Male , Aged , Middle Aged , Adult , Urinary Retention , Prostatic Hyperplasia , Edetic Acid , Transurethral Resection of Prostate , Urinary Catheterization , Lower Urinary Tract Symptoms , UrinationABSTRACT
Objectives:To investigate the effects of transurethral electrovaporization of the prostate(TUVP)plus transurethral re-section of the prostate(TURP)for patients with benigh prostate hyperplasia(BPH).Methods:The technique of TUVP plus TURP was employed to treat 114 cases of BPH.Results:All patients underwent successful TUVP and TURP procedure intraoperatively,and recovered very well postoperatively.No serious complications were noted.Conclusions:TUVP plus TURP is a feasible and safe technique for patients with BPH.